BMC Pregnancy and Childbirth最新文献

Background: For many women, having a baby is one of the most exciting and rewarding experiences; however, not everyone experiences the same positivity and pleasure when pregnant or having a new baby. For some, the ongoing hormonal and physical changes, mood swings, and personal and familial situations can create a lonely experience that can lead to distress and mental health issues. Wāhine Māori (Māori women) experience greater rates of postnatal distress (PND) and are less likely to seek help than women of European descent. Screening for PND could help identify those at risk of developing mental health issues or distress before it escalates. However, it is unclear how often Māori mothers are screened, or what their experiences of screening are.

Method: Using a Māori-centred approach, we explored the experience of wāhine Māori of mental health screening during the perinatal period.

Results: Eleven wāhine Māori were interviewed about their experiences, with transcripts analysed using thematic analysis. Four themes and 12 subthemes were found in the data. Participants reported feeling a lack of relationship with their midwives, experiencing inconsistent care, lacking trust, that their views were unimportant, fearing judgment, concerns about losing their children to authorities if they disclosed mood issues and a lack of culturally appropriate care.

Conclusions: There was an overall sense of inadequate screening support for mental health concerns among Māori mothers in Aotearoa New Zealand. These results indicate the need for more culturally appropriate screening tools and a genuinely holistic approach to perinatal services encompassing a more whānau-centred approach to maternal care.

Non-communicable diseases (NCDs) represent the leading cause of death and disability worldwide, and those NCDs contributing most burden - cardiometabolic illness, diabetes, cancer, chronic respiratory disease - can be largely prevented through improvements in health behaviours such as tobacco use, harmful use of alcohol, exposure to environmental hazards, unhealthy dietary habits, and physical inactivity. Despite concerted efforts at all levels of health care provision and policy, population-level health behaviour change still presents an ongoing challenge to primary care clinicians, public health practitioners, health promotion specialists and government agencies around the world. An individual's age can influence their health behaviour decision-making as younger people often perceive the potential implications of their current poor health behaviours as remote in time and possibility, which may significantly limit their motivation to make a positive health behaviour change in the present. Yet public health researchers and practitioners recognise that a lifecourse approach to public health policies and interventions has the potential to reduce the risk of NCDs developing before conception and throughout life, as well as impacting the transmission of the benefits of health improvement from one generation to the next. Given the growing awareness of the benefits of a lifecourse approach to public health, a focus on improving preconception health at a population-level provides a unique opportunity for behaviour change motivation, NCD prevention and reducing inequalities across generations. Through this narrative review, we describe how three main public health strategies - health policy, health promotion and health services - may address the challenge of improving preconception health. We also explore the potential value of leveraging parental motivation in the preconception period to achieve positive health behaviour change and, in doing so, meet broader public health goals. We set out a framework for drawing on established public health methods and priorities to address structural inequalities and harness parental motivation and concern for their offspring to build and enable new and positive health behaviours that benefit current and future generations.

Background: Adolescent pregnancy is associated with adverse outcomes, and although there has been a global decline in the incidence of teenage pregnancies and neonatal deaths, the absolute number remains significant. This study aimed to evaluate temporal trends in live births and neonatal deaths from adolescent mothers, as well as to identify the effect of adolescent pregnancy on neonatal death.

Methods: This is a population-based study of all live births from mothers residing in Sao Paulo state, Brazil, between 2004 and 2020. The Prais-Winsten model was used to analyze annual trends for live births from adolescent mothers, neonatal mortality rates, and the percentage of neonatal deaths within specific demographic groups. The Kaplan-Meier survival curve evaluated the time to neonatal death. A Poisson regression model was utilized to identify maternal and neonatal characteristics associated with the risk of neonatal death.

Results: The present study encompassed a total of 9,870,181 live births, with 14.4% occurring to adolescent mothers. There were 75,504 neonatal deaths, with 14,159 (18.8%) of those occurring in the neonates born to adolescent mothers. The annual percentage change in live births to adolescent mothers decreased by -3.03% (95%CI: -4.12% to -1.93%). The neonatal mortality rates showed a declining trend within both adolescent and non-adolescent mothers. Infants born to adolescent mothers had a higher probability of neonatal death and an earlier age of death when compared to non-adolescent mothers' infants. Poisson multiple regression analysis indicated an elevated risk of neonatal death for seven tested variables (adolescent mothers, inadequate prenatal care, multiple gestation, non-hospital delivery, low birth weight, male sex and congenital anomalies) and a reduction on risk of death for neonates born from cesarean section.

Conclusions: The study showed a reduction in live births to adolescent mothers and neonatal deaths among adolescent mothers from 2004 to 2020 in the state of Sao Paulo. Was also shown a risk association between been born to adolescent mothers and neonatal death.

Introduction: Short inter-birth intervals negatively impact maternal and child health; however, data on their prevalence and associated factors in Tanzania are limited. This study investigates the prevalence of short inter-birth intervals and the associated factors among women of reproductive age in Tanzania.

Methods: This was a cross-sectional study utilizing the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey dataset. The study population included women aged 15-49 years with at least two births within five years preceding the survey. A short inter-birth interval was defined as a birth occurring < 33 months after the preceding birth. A generalized linear model with Poisson as a link and robust standard errors was used to examine factors associated with short inter-birth intervals. A p-value < 0.05 was considered statistically significant.

Results: A total of 8,350 births from 6,034 women were included in this analysis. The mean (± SD) age of the women was 31.6 ± 6.8 years. The overall prevalence of short inter-birth intervals was 42.6%. Younger age (aPR 3.12, 95% CI 2.88-3.52 for age 15-24 years, and aPR 1.74, 95% CI 1.62-1.1.86 for age 25-34 years), being married (aPR 1.27, 95% CI 1.03-1.57), late age at first childbirth (aPR 1.24, 95% CI 1.17-1.32) for a 20-24 years and aPR 1.55, 95% CI 1.39-1.73 for ≥ 25 years), and higher birth order (aPR 1.02, 95% CI 1.03-1.19; aPR 1.24, 95% CI 1.14-1.34; aPR 1.72, 95% CI 1.58-1.86 for 3rd, 4th, and 5th or more birth orders, respectively, compared to 2nd birth order) were independently associated with short inter-birth intervals. Additionally, there was significant variation in the prevalence of short inter-birth intervals across different zones and levels of household wealth. Women from richer (aPR 0.87, 95% CI: 0.80-0.95) and richest (aPR 0.84, 95% CI: 0.74-0.94) households exhibited a lower prevalence of short inter-birth intervals.

Conclusion: This study highlights the significant prevalence of short inter-birth intervals among women of reproductive age in Tanzania. The associated factors include younger age, marital status, delayed first childbirth, higher birth order, geographical disparities, and lower household wealth. These findings highlight the need for targeted interventions to promote birth spacing and improve maternal and child health outcomes.

Objective: This study aimed to investigate the risk factors and pregnancy outcomes associated with recurrent tuberculosis (TB) during pregnancy among patients with a history of TB who underwent in vitro fertilization and embryo transfer (IVF-ET).

Methods: A retrospective case-control study was conducted at the Reproductive Center of Lanzhou University First Hospital, covering the period from January 2005 to September 2023. The study included infertile patients who had undergo IVF and had a documented history of TB. Patients who experienced recurrent TB during pregnancy were designated as the study group, while those who did not experience recurrence were assigned to the control group, matched at a 1:2 ratio. Both univariate and multivariate analyses were performed to identify risk factors associated with pregnancy outcomes.

Results: Pregnancy and neonatal outcomes were significantly worse among patients in the study group who experienced TB recurrence following IVF-ET. Among the 26 patients in the study group, only four achieved live births, with two neonatal deaths occurring within two months of delivery. Significant risk factors for TB recurrence identified included the GnRH agonist protocol, elevated estradiol and progesterone levels on the trigger day, and twin pregnancies (P < 0.05). Further multivariate analysis confirmed that high estradiol levels (≥ 5000 pg/ml) on the trigger day and twin pregnancies were independent predictors of TB recurrence.

Conclusion: Elevated estradiol levels (≥ 5000 pg/ml) on the day of human chorionic gonadotropin (hCG) trigger, as well as twin pregnancies, have been identified as independent risk factors for recurrent TB among pregnant patients with a history of TB who undergo embryo transfer. Given these findings, it is advisable for such patients to consider single embryo transfer and to utilize frozen embryo transfer cycles to mitigate the associated risks.

Background: This retrospective cohort study aimed to investigate the correlation between vaginal infections and adverse pregnancy outcomes in a Chinese obstetric population.

Methods: This study was conducted at the International Peace Maternity and Child Health Hospital in Shanghai from 2021 to 2023. The primary objective was to assess the incidence of various vaginal infections and their associations with preterm birth (PTB), low birth weight (LBW), and preterm premature rupture of membranes (PPROM). Data were collected from medical records, with vaginal infection diagnoses confirmed through standard laboratory procedures. This study included women who registered and delivered at our hospital between 2021 and 2023. Strict exclusion criteria were applied to control confounding factors, excluding women with a history of syphilis, human immunodeficiency virus infection, hepatitis virus infection, or non-live birth outcomes. Continuous variables were analyzed using the Mann-Whitney U test, whereas categorical variables were assessed using the Pearson chi-square test or Fisher exact test. Logistic regression analysis was employed for multivariate assessments to determine whether vaginal infections were independent risk factors for adverse pregnancy outcomes.

Results: Vaginal infections were significantly associated with adverse pregnancy outcomes. Women with vaginal infections had higher rates of PTB (15.65% vs. 9.16%, P < 0.001), LBW (10.82% vs. 5.93%, P < 0.001), and PPROM (7.41% vs. 5.31%, P < 0.001) compared with their uninfected counterparts. Mixed vaginitis demonstrated a stronger association with these adverse outcomes compared with single infections. The timing of infection during pregnancy emerged as a critical determinant of the risk of adverse outcomes.

Conclusions: The study underscores the critical need for comprehensive screening and management of vaginal infections during pregnancy to improve maternal and neonatal health. Targeted interventions, particularly in the later stages of pregnancy, are essential to mitigate the risks associated with vaginal infections. Future research should focus on developing more effective screening methods and therapeutic strategies to address the specific types of vaginal infections and their effects on pregnancy outcomes.

Background: Despite the known benefits of skin-to-skin contact (SSC), limited data exists on its implementation, especially its influencing factors. The current study was designed to use machine learning (ML) to identify the predictors of SSC.

Methods: This study implemented predictive SSC approaches based on the data obtained from the "Iranian Maternal and Neonatal Network (IMaN Net)" from January 2020 to January 2022. A predictive model was built using nine statistical learning models (linear regression, logistic regression, decision tree classification, random forest classification, deep learning feedforward, extreme gradient boost model, light gradient boost model, support vector machine, and permutation feature classification with k-nearest neighbors). Demographic, obstetric, and maternal and neonatal clinical factors were considered as potential predicting factors and were extracted from the patient's medical records. The area under the receiver operating characteristic curve (AUROC), accuracy, precision, recall, and F_1 Score were measured to evaluate the diagnostic performance.

Results: Of 8031 eligible mothers, 3759 (46.8%) experienced SSC. The algorithms created by deep learning (AUROC: 0.81, accuracy: 0.75, precision: 0.67, recall: 0.77, and F_1 Score: 0.73) and linear regression (AUROC: 0.80, accuracy: 0.75, precision: 0.66, recall: 0.75, and F_1 Score: 0.71) had the highest performance in predicting SSC. Doula support, neonatal weight, gestational age, attending childbirth classes, and maternal age were the critical predictors for SSC based on the top two algorithms with superior performance.

Conclusions: Although this study found that the ML model performed well in predicting SSC, more research is needed to make a better conclusion about its performance.

Background: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection in pregnant women have an adverse impact on perinatal outcomes, including cesarean section, preterm birth, fetal distress. However, it's uncertain whether these adverse consequences are caused by previous SARS-COV-2 infection during pregnancy or acute infection at the time of delivery.

Methods: We conducted a single-center retrospective cohort study among pregnant women with singleton pregnancy who delivered between 1 December 2022 and 1 February 2023 (n = 2472). Pregnancies were divided into three groups: non-infected group, acute SARS-CoV-2 infection group, prior SARS-CoV-2 infection group based on PCR or antigen test. The clinical data for mothers and neonates came from medical records on internal healthcare system. Follow-up time spanned from admission to discharge. We investigated the impact of acute and prior SARS-CoV-2 infection on maternal and neonatal outcome. Multivariable logistic models were used to assess the risk of adverse perinatal outcome in pregnant women with acute and prior SARS-CoV-2 infection.

Results: Compared to the non-infected pregnant women, acute SARS-CoV-2 infected pregnant women had significant higher rates of intrahepatic cholestasis of pregnancy (ICP) (26 women [4.4%] vs. 8 women [1.0%]; aOR, 4.9 [95% CI, 2.2-11.0]; P < 0.001), preterm birth (<37 wk) (53women [9.0%] vs. 45 women [5.7%]; aOR, 1.7 [95% CI, 1.1-2.7]; P < 0.05), fetal distress(106 women [18.1%] vs. 82 women [10.4%]; aOR,1.9 [95% CI, 1.4-2.6]; P < 0.01), primary cesarean delivery (216 women [36.9%] vs. 239women [30.3%]; aOR, 1.4[95% CI, 1.1-1.8]; P < 0.01) and neonatal unit admission (69 neonates [12%] vs. 64 neonates [8.3%]; aOR, 1.6 [95% CI, 1.1-2.3]; P < 0.05), prior SARS-CoV-2 infection were associated with an increased risk of ICP (40 women [3.7%] vs. 8 women [1.0%]; aOR, 3.9 [95% CI, 1.8-8.5]; P <0.001).

Conclusions: Pregnant women at delivery with acute SARS-CoV-2 infection were associated with higher risk of ICP, preterm birth, fetal distress, primary cesarean delivery and neonatal unit admission. Prior SARS-CoV-2 infection during pregnancy was associated with higher risk ICP. These findings emphasize the need for optimization of strategies for prevention of SARS-CoV-2 infection in pregnant women, especially for acute infection at delivery.

Background: Current methods used to assess the progress of labor are often invasive and may cause discomfort to the mother. The purple line offers potential as a non-invasive marker for monitoring the labor process. However, its sensitivity and specificity in assessing critical components of labor, such as cervical dilatation and fetal descent, have not been adequately studied in different populations. This study was conducted to evaluate the effectiveness of the purple line, a method for assessing labor progress.

Methods: Data for this observational study were collected from 304 pregnant women who presented to a maternity hospital for birth on the Anatolian side of Istanbul between May and November 2021. The inclusion criteria for the study were that women were 38-42 weeks of gestation, spontaneous labor had started and were in active labor phase. Participants were selected by random sampling method among women who met the study criteria during labor. Data collection included demographic information, partograph records, and measurements of the purple line. Women's birth was assessed and documented on a partogram, with the purple line measured hourly via a disposable tape measure until birth. Descriptive analyses including means and standard deviations, medians and interquartile ranges, and cut-off point and sensitivity-specificity (ROC) values were performed for data analysis.

Results: A purple line was seen in 85.9% of pregnant women at any stage of labour, with a specificity of 86% and sensitivity of 65%. During the active phase of labor, the measurements of the purple line length in the sacral region increased proportionally with cervical dilatation. The sensitivity was 56%, and the specificity was 65% when the fetal head descent reached the - 2 level.

Conclusions: In conclusion, the purple line in the sacral region is a non-invasive method to assess the course of labor and can be used as an adjunct to vaginal examinations and may reduce the number of vaginal examinations in clinical settings.